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Latest News and Updates for What Works? A Guide to Quit Smoking Methods

On January 1, 2011, NTCC officially launched the website for What Works? A Guide to Quit Smoking Methods. This website contains all of the information on the What Works card, as well as more detailed information about each cessation method. Supported by a modest paid online campaign, the What Works website has received more than 8,500 visits to date.

In an effort to continue promotion of the Guide and website, we invite all NTCC partners to endorse this resource by sharing the link (whatworkstoquit.tobacco-cessation.org) to the companion website on your Facebook and Twitter accounts. Please find below some suggested language for sharing:

Facebook:

Suggested Update: Have you or someone you know decided to quit smoking in 2011? The NTCC just released What Works? A Guide to Quit Smoking Methods. It compares quit smoking methods, products, costs, success rates and where to find resources.
LINK: whatworkstoquit.tobacco-cessation.org

Twitter:

Suggested Tweet1: Compare 17 different quit smoking methods and make 2011 the year you quit smoking for good: http://bit.ly/whatworks2quit

In response to expert feedback, NTCC re-evaluated the method for determining the star ratings for each cessation method. Dr. Michael Fiore and others on the Guideline panel updated the star ratings to more accurately reflect that, in most instances, research studies of smoking cessations medications include some form of counseling. Please visit whatworkstoquit.tobacco-cessation.org for the latest version of the Guide.

Lastly, NTCC has recently conducted usability testing of the What Works? website with smokers interested in quitting smoking. Findings from this study will be written into a report and shared with NTCC partners.

Background
NTCC, through funding from the Robert Wood Johnson Foundation, developed a “Consumer Reports” style card,What Works? A Guide to Quit Smoking Methods, to help smokers choose appropriate methods for quitting. The content of the card is based on Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline, and was developed in collaboration with Dr. Michael Fiore and others on the Guideline panel. To supplement the printed Guide, a companion website was developed to provide smokers with more detailed information. Visitors to the website can review explanations of each of the cessation approaches, common side effects, point of contact regarding questions, and more.

Research Highlights

Studies Decipher How Anti-Smoking Drugs Work

Two drugs that help people stop smoking -- bupropion and varenicline -- may change the way the brain reacts to seeing someone else smoke, new studies report.

And that may be how they cut cravings.

Bupropion (Wellbutrin, Zyban) is prescribed around the world to help people resist smoking cues. But it has not been clear how the drug does this. Using brain scans, Christopher S. Culbertson, of the University of California, Los Angeles, and his colleagues examined what happened in the brains of 30 smokers who took the drug or a placebo for eight weeks.

The researchers gauged how much the participants craved cigarettes by asking them to respond after watching "neutral" cues that did not involve smoking or 45-second videos of actors and actresses smoking.

Those who took the drug instead of the placebo reported less craving. They also showed less activity in areas of the brain linked to craving.

"These results demonstrate that treatment with bupropion is associated with an improved ability to resist cue-induced craving and a reduction in cue-induced activation of limbic and prefrontal brain regions," the study authors wrote.

In a second study, Teresa Franklin of the University of Pennsylvania and her colleagues used brain scans to study how the brains of 22 smokers reacted when they took the drug varenicline (Chantix) or a placebo for three weeks. The participants watched 10-minute videos, some of which included smoking cues.

Those who took the drug had less brain activity in some areas and reported less craving after they saw the videos designed to provide smoking cues.

"The results of our study reveal a distinctive new action of varenicline that may contribute to its clinical efficacy," the researchers wrote. "Unsuccessful smoking cessation is more prevalent in individuals with psychiatric illness, suggesting that they have greater difficulty quitting. Varenicline and other medications that can reduce both withdrawal and cue reactivity may be of special benefit to these subgroups."

Both studies were published online Jan. 3 in the Archives of General Psychiatry.

Quitting Smoking Improves Cholesterol

Smokers who successfully quit may enjoy yet another health benefit: improved cholesterol profiles. A boost in "good" cholesterol comes with quitting despite weight gain after putting out the last cigarette, hints a new study.

If confirmed in future research, the finding could shed light on the strong, yet somewhat mysterious relationship between smoking and heart health. Up to 20 percent of heart disease deaths are currently blamed on smoking, but researchers haven't yet had a clear understanding of what lies behind the effect. Smoking likely affects the cardiovascular system in a variety of ways, including lowered oxygen levels and wear and tear on the heart itself.

Some small studies have also shown that smoking lowers good cholesterol (HDL) and raises bad cholesterol (LDL), lead researcher Dr. Adam Gepner of the University of Wisconsin School of Medicine and Public Health, in Madison, told Reuters Health in an e-mail.

To test the impact of smoking on cholesterol levels more rigorously, and in a realistic setting, Gepner and his colleagues recruited more than 1,500 smokers representative of the current U.S. population, including its high proportion of overweight and obese individuals.

The average participant smoked about 21 cigarettes per day prior to the start of the study. After a year on one of five smoking cessation programs, 334 (36 percent) had succeeded in quitting.

The researchers found that those who stopped smoking experienced an average rise of about 5 percent, or 2.4 milligrams per deciliter (mg/dL), in HDL cholesterol.

Abstainers also experienced an increase in large HDL particles, which are important for lowering heart disease risk as well, report the researchers in the American Heart Journal.

The effects were somewhat stronger in women. However, it did not appear to matter how many cigarettes were smoked at the start of the study: heavy smokers enjoyed the same HDL benefit as lighter smokers after they quit.

One downside of kicking the habit can be weight gain. Sure enough, the group that quit gained an average of about 10 pounds compared to one or two pounds in the group that relapsed to smoking. Many participants were already overweight at the start of the study, with an average body mass index (BMI) of 29.6. (A BMI between 20 and 25 is generally considered healthy).

Adding pounds is known to hurt cholesterol levels, both raising the bad kind and lowering the good kind. As a result, the researchers think the weight gain might have offset some of the beneficial effects seen in the abstainers.

"Further benefits on cholesterol levels may have been actually masked by the weight gain seen after quitting," explained Gepner.

"It is important to counsel quitters about weight gain and the need for a healthy diet and regular exercise during the quitting period," he added.

The researchers caution that their results don't prove that smoking cessation causes improvements in cholesterol. Further research is needed to rule out other possible explanations, including the role of changes in alcohol consumption, which is known to affect HDL.

Gepner also noted that it remains unclear exactly how smoking cessation might affect cholesterol levels, although it could have to do with changes in the proteins that control the breakdown of cholesterol. Smoking can damage these proteins.

Regardless, benefits were seen that might translate into better heart health.

Previous studies have shown, for example, that for every 1 mg/dL increase in HDL cholesterol, the risk of a cardiovascular event drops by up to three percent over 10 years.

Therefore, if the link holds, the improvements in blood lipids alone would decrease the average former smoker's risk of a heart attack or stroke by up to 6 percent over the 10 years after they quit, said Gepner.

Smoking Cessation Linked to Happiness, Elevated Moods

As if you needed another reason to give up smoking for good: Researchers have now determined that successfully quitting is not only linked to greater happiness, but also to elevated moods, contrary to the popular belief that abandoning the habit makes you miserable.

The study, which was conducted at Brown University and published in the journal Nicotine & Tobacco Research, evaluated 236 male and female smokers, before and during the process of quitting. After undergoing standardized tests for symptoms of depression, participants were counseled on smoking cessation and given nicotine patches to aid them along the way. Further counseling sessions took place at 2, 8, 16 and 28 weeks after their quit dates, regardless of whether or not participants were still smoking.

What researchers found were that those who were able to quit smoking, even for a short time, reported very high spirits during their checkups, while those who failed reported moods that were even darker than when the study began. Those participants who failed right away and never abstained (99 people total) were found to be unhappiest of all the groups, while those who avoided smoking for the whole length of the study reported the highest levels of happiness.

The findings are persuasive, but the methods the investigators used do give reason for pause. All of the 236 subjects surveyed were also heavy drinkers, and when it comes to a study of mood, alcohol is about the most confounding variable imaginable. Lead author Christopher Kahler told Healthland that the use of heavy drinkers was important because this group typically has low rates of success in quitting smoking, and in general, alcohol is often involved when people go back to smoking after quitting the habit. However, he notes that they did not see a correlation between changes in drinking and depressive symptoms, as most participants continued to drink during the course of the study.

Kahler maintains that smokers who are thinking of quitting should feel encouraged by the results of the study, telling Medical News Today:

The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode. What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression.

Just one more reason to follow through with your resolution to quit smoking this year.

Smoking 'Causes Damage in Minutes', US Experts Claim

The report, published in Chemical Research in Toxicology, shows that chemicals which cause cancer form rapidly after smoking.

Scientists involved in the small-scale study described the results as a stark warning to people considering smoking.

Anti-smoking charity Ash described the research as "chilling" and as a warning that it is never too early to quit.

The long term impact of smoking, from heart disease to a range of cancers, is well known. This study suggests the damage begins just moments after the first cigarette is smoked.

Faster Than You Might Think

The researchers looked at the level of chemicals linked with cancer, polycyclic aromatic hydrocarbons (PAH), in 12 patients after smoking.

A PAH was added to the subject's cigarettes, which was then modified by the body and turned into another chemical which damages DNA and has been linked with cancer.

The research shows this process only took between 15 and 30 minutes to take place.

Professor Stephen Hecht, from the University of Minnesota, said: "This study is unique, it is the first to investigate human metabolism of a PAH specifically delivered by inhalation in cigarette smoke, without interference by other sources of exposure such as air pollution or the diet.

"The results reported here should serve as a stark warning to those who are considering starting to smoke cigarettes."

Martin Dockrell, director of policy and research at Ash (Action on Smoking and Health), said: "Almost everybody knows that smoking can cause lung cancer.

"The chilling thing about this research is that it shows just how early the very first stages of that process begin - not in 30 years but within 30 minutes of a single cigarette for every subject in the study.

"The process starts early but it is never too late to quit and the sooner you quit the sooner you start to reduce the harm."

Combination of Phone, Web Services Boosts Quit Rates for Smokers

Smokers using a Web-based smoking cessation tool in tandem with phone counseling for 18 months had nearly double the quit rates compared with smokers enrolled only in the online program, according to study published in the Archives of Internal Medicine, reports Reuters.

Study Details

Led by the American Legacy Foundation's Schroeder Institute for Tobacco Research and Policy Studies, the study used QuitNet.com, an online tool launched in 1995 that has more than 60,000 monthly users. The study authors randomly assigned 2,000 smokers to three groups:

The first group received phone counseling and premium QuitNet membership;

A second group had only premium access to the online tool; and

A third group was given access to a static website that was created for the purposes of the study and offered general advice.

Study Findings

After 18 months, 15 percent of phone and premium members reported that they had not smoked since the start of the study, compared with 8 percent of those in the premium program only and 6 percent of users of the basic online program.
Victor Strecher -- a University of Michigan public health professor not affiliated with the study -- said, "These were significant differences, even though they may look small."
According to the National Cancer Institute, fewer than 5 percent of all smokers who try to quit without assistance succeed (Boerner, Reuters, 1/12).

Risks of Thirdhand Cigarette Smoke Can Linger

Thirdhand smoke, the nicotine residue that is left behind on furniture, walls, and carpeting after a cigarette has been smoked in a room, can become airborne a second time, a new study shows.

The resulting particulates, a toxic mix of ozone and nicotine, are so small that they can easily penetrate into the deepest parts of the lung, and over time, scientists say, could contribute to breathing problems like asthma or even cancer.

“Quantitatively, exposure via secondhand smoke is much greater and a more likely concern with regards to health,” says study researcher Yael Dubowski, PhD, a senior lecturer at Technion-Israel Institute of Technology in Haifa, Israel. “However, exposure to harmful compounds via thirdhand smoke and thirdhand smoke transformations is an additional source for skin and lung exposure.

”What’s more, Dubowski says, because ozone can continue to pull nicotine off surfaces and back into the air for months, exposure to thirdhand smoke may continue long after smoking in the area has ceased.

A Third Way to Be Exposed to Cigarette Smoke

It’s long been known that mainstream and secondhand smoke can contribute to health problems ranging from cancer to heart disease to birth defects.

Only recently have scientists have begun to measure and understand the dangers of exposure to thirdhand smoke.

“There’s nicotine in tobacco smoke, obviously. The portion of that nicotine that’s not absorbed by the human body, that nicotine goes someplace, and one of the places it goes is that it sticks on the surfaces of the room that you’re in,” says James F. Pankow, PhD, professor of chemistry and civil and environmental engineering at Portland State University in Oregon.

Previous research has shown that thirdhand smoke can rub off onto skin and even be ingested if food is eaten that’s been exposed to smoke. It was also shown that dust could carry thirdhand smoke to the lungs.

The new study, which is published in the journal Environmental Science & Technology, shows that nicotine residues can interact with other indoor air pollutants and become airborne again.

“Nicotine can come back off of that surface to react with ozone,” says Pankow, “It forms particles.”

Those particles, known as secondary organic aerosols, are so small that they may be inhaled deeply into the lungs, where they are hard for the body to clear.

Studying Cigarette Residues

For the study, Dubowski and her team impregnated three different kinds of materials, cellulose (a proxy for plant-based building materials like wood), paper, and cotton, with nicotine and exposed them to ozone under dry and humid conditions.

They were able to see that nicotine remained on the surfaces to be wiped off onto skin or clothing.

They were also able to measure, however, that nicotine could “desorb” off a surface back into the air where it might be inhaled on its own or react with other indoor air pollutants like ozone to form particulates.

The researchers also found that humid conditions appeared to be somewhat protective against exposure to the products of thirdhand smoke.

“This may not be very significant under normal indoor conditions where relative humidity is governed by comfort and kept around 60 percent,” says Dubowski. “However, in airplanes, where relative humidity is particularly low, less than 20 percent, and ozone concentrations can reach higher than 100 parts per billion, the potential for exposure to products of thirdhand smoke products may be greater.”

Secondhand Smoke Tied to High Blood Pressure in Kids

Young kids who live with a parent who smokes face an increased risk for developing high blood pressure while still children, a new study has found.

Warning that children with high blood pressure often become adults with the same problem, the researchers suggested that secondhand smoke poses a substantial and long-term risk to the cardiovascular welfare of young children.

"The prevention of adult diseases like stroke or heart attack begins during childhood," said the study's lead author, Dr. Giacomo D. Simonetti, an assistant professor of pediatrics at the Children's Hospital at the University of Bern, in Switzerland. "Removing any avoidable risk factors as soon as possible will help reduce the risk for heart disease later on and improve the long-term health of children."
And, he added, "Passive smoking is a risk factor.

And an avoidable risk factor. So do not smoke because it is not healthy for you and for your children. Smoking increases your — and your children's — blood pressure."

Simonetti, who worked on the study while at the University of Heidelberg in Germany, and his colleagues report their findings in the Jan. 10 online edition of Circulation.

The researchers noted that high blood pressure is the prime risk factor for heart disease. And according to the American Cancer Society, about 46,000 non-smoking Americans die from heart disease each year as a result of living with smokers and the secondhand smoke they produce.

To gauge the impact of secondhand smoke on young children, the research team examined data on 4,236 healthy boys and girls, 5 to 6 years old, who lived in southwestern Germany. Nearly 29 percent of the children's fathers and almost 21 percent of their mothers were smokers. For about 12 percent of the children, both parents smoked.

Even after accounting for other heart disease risk factors — such as low weight at birth, premature birth, high body mass index and parents with high blood pressure — parental smoking appeared to be an independent risk factor for high blood pressure among the children, the study found.

In fact, children exposed to parental secondhand smoke were 21 percent more likely to have the upper number of their blood pressure reading (the systolic figure, which corresponds to heart contractions) register at levels among the highest 15 percent of the population.

Mothers who smoked appeared to confer a worse impact on their child's blood pressure levels than smoking fathers, although the researchers said that likely reflected maternal lifestyle and the generally greater amount of time the mothers spent in the home.

Dr. Gregg C. Fonarow, a cardiology professor at the University of California, Los Angeles, expressed little surprise at the findings.

"We certainly know that secondhand smoke is dangerous and associated with adverse consequences," he noted. "In adults, there's certainly higher heart attack and stroke risk, as well as lung disease. And it's previously been known that secondhand smoke can be dangerous to children's lungs," he added.

"This look at its impact on blood pressure just reinforces the notion that there's no acceptable exposure to secondhand smoke when it comes to infants and young children," Fonarow said. "And it's yet another reason why we need to protect them from exposure because it damages their lungs and blood vessels and can already manifest in harm to their blood pressure."

Smoking May Worsen Cancer Pain

A new study shows that smokers who continue to light up after being diagnosed with cancer may experience more pain and more pain-related disruption in their daily lives, compared to nonsmokers.

Smoking is already known to greatly contribute to a person’s risk of developing cancer, but researchers say this study suggests that smoking may also contribute to pain in people with various types of cancer.

In the study, researchers compared smoking status and pain levels of 224 cancer patients about to start chemotherapy. The participants answered questions about their pain severity, pain-related distress, and pain-related interference in their daily lives.

For example, they rated their perceived severity of bodily pain on a scale from one to six and the degree to which the cancer pain interfered with daily activities.

The results showed that current smokers reported higher levels of pain than people who had never smoked. Smokers also appeared to be more bothered by their cancer pain.

“Patients who continued to smoke despite their cancer diagnoses reported greater interference from pain than either former smokers or never smokers,” researcher Joseph W. Ditre, PhD, of the department of psychology at Texas A&M University and colleagues write in the journal Pain.

In addition, researchers found an inverse relationship between cancer pain and the number of years since quitting smoking among former smokers. Cancer pain decreased the longer it had been since they stopped smoking.

"Although more research is needed to understand the mechanisms that relate nicotine to pain, physicians should aggressively promote smoking cessation among cancer patients,” Lori A. Bastian of Duke University writes in an editorial that accompanies the study. “Preliminary findings suggest that smoking cessation will improve the overall treatment response and quality of life."

Other Cessation News

Quitting Smoking Makes Economic Sense

Even though some of the tools to help smokers quit can be expensive, such as counseling sessions and prescriptions, the cost of continuing to smoke is much higher.

What does it cost to stop smoking?

For just about anyone, less than it does to keep smoking. Many smokers burn through thousands of dollars each year buying cigarettes alone. Then there are peripheral costs like breath mints, extra trips to the dry cleaner and higher premiums for health insurance.

Quitting costs money too, but it's a better long-term investment. Plus, much of what you'll need to get started — nicotine gum, patches and even counseling sessions — is often available free.

"The cost of quitting isn't typically the reason smokers give for not giving up the habit," says Dr. Cheryl Healton, president of the American Legacy Foundation, a smoking cessation advocacy group based in Washington, D.C. "But finding out that it can be a very manageable cost is good news for smokers who make the decision to stop."

Nationwide, the average cost of a pack of cigarettes (including the federal cigarette tax and state sales taxes) is about $5.51, according to the Campaign for Tobacco-Free Kids in Washington, D.C. For those who smoke a pack a day, that works out to about $155 a month, or just over $2,000 a year.

Quitting, on the other hand, generally costs $25 to $150 a month, according to Dr. Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention. One-on-one counseling may add to the tab, he said.

Smokers may need to make several attempts before they kick the habit for good, and the final attempt at quitting generally takes two to three months, he said.

The very first step can cost nothing — call the toll-free number (800) QUIT-NOW (1-800-784-8669) for a referral to the quit-smoking line in your state. Staffers can mail you smoking cessation materials and refer you to support groups and free one-on-one phone counseling. In many cases, quit-line operators can even provide an initial supply of some nicotine replacement products.

Another free resource is Smokefree.gov, a Department of Health and Human Services website. You can get a free copy of the Quit Guide, which will walk you through steps to take on "Quit Day" and help you manage your cravings. The site's medication guide has detailed information on over-the-counter and prescription drugs to help wean yourself off cigarettes. You can also have an online chat with a smoking cessation counselor or find out how to enroll in a clinical trial.

Gum, lozenges, patches, inhalers and nasal sprays can all be used to deliver the nicotine hit you'd otherwise get from a cigarette. These typically run about $30 to $100 a month, though some insurers cover the monthly cost of inhalers and sprays, which must be prescribed by a physician. Doctors may also have some samples to share.

Two drugs, Chantix and Zyban, have been approved for smoking cessation. Chantix works by preventing the release of dopamine — a chemical associated with feelings of pleasure and desire — when nicotine from tobacco reaches nicotine receptors in the brain. As a result, the drug is designed to reduce the enjoyment of smoking. The mechanism of Zyban is less clear, but the drug is able to turn off nicotine cravings in many smokers.

Monthly prescriptions for these medications can cost $70 to $200, depending on the dose your doctor prescribes and whether you use Zyban or a generic version. (There is no generic alternative to Chantix.) If that's beyond your budget, prescription drug assistance programs such as Partnership for Prescription Assistance (888-477-2669) and NeedyMeds may be able to help you get free or discounted drugs, depending on your income and insurance coverage.

You can also cut costs by asking your healthcare provider for coupons or searching for them online at sites like http://www.InternetDrugCoupons.com. The savings can be significant — one recent coupon offered up to $30 off the cost or co-pay for Chantix. Generic versions of the patches, gum and lozenges can reduce the price by up to half.

Telephone counseling and support groups are usually free or cost very little. Quit-lines, doctors and hospital community service departments can make referrals to these services.

Phone counseling is usually spread over four sessions, says Ines Parks of the American Legacy Foundation. A quit date will be set during the first session, and the others come after that date so the counselor can focus on managing cravings and smoking triggers, such as stress.

Support groups usually include eight to 12 people and are led by trained specialists. They typically meet once a week for about eight weeks, Parks says.

Each type of counseling has its own strengths, but a 1998 study in the Journal of Preventive Medicine found that when smokers were offered a choice of phone or support group counseling, 70 percent chose phone counseling.

To boost your odds of success, experts at the Office on Smoking and Health at the federal Centers for Disease Control and Prevention say it's best to attack your addiction from multiple angles. A 2007 study of 4,614 smokers published in the journal Tobacco Control found that 19 percent of people were able to go smoke-free for 30 days when they combined phone counseling with nicotine replacement therapy, compared with only 13 percent of those who relied on counseling alone.

For some people, one-on-one, face-to-face counseling works best. Sessions can cost $25 to $200 an hour depending on the type of professional you see. Insurance may cover some or all of the cost — as of Jan. 1, for instance, Medicare covers the cost of up to four counseling sessions for any beneficiary who tries to quit, and they can make two attempts per year. Previously, that benefit was available only to those who already had a tobacco-related disease.

Even if it gets pricey, quitting is still a bargain. According to the CDC, the total health costs of smoking work out to $10.47 per pack of cigarettes.

Resolved to Quit Smoking This Year?

Although smoking is an expensive habit, let's face it, nicotine replacement therapies (NRT) to help you quit smoking can seem like expensive purchases as well. The reluctance to spend money on NRT leads many smokers to try to do it "cold turkey" – the most popular method for quitting smoking, but also one that frequently leads to relapse.

The use of store brand over-the-counter aids or medication to quit smoking can triple your chances of success. Two of the more common over-the-counter aids are nicotine polacrilex gum and nicotine lozenges. These therapies are oral dosage forms of nicotine replacement therapies and work as temporary aids to help you quit smoking by reducing nicotine withdrawal symptoms. Other effective smoking cessation products, including patches, nasal sprays and medication, are available both over-the-counter and by prescription.

Store Brand Savings

There are a number of options consumers have to save money on quitting smoking therapies. The first option is to consider purchasing store brand NRT products. Store brand products offer significant savings over the national brand and are equivalent to the national brand, in terms of FDA quality standards and efficacy. The store brand NRT products can be found at leading retailers across the nation.
Regularly monitor retailers' circular flyers and websites, and remember retailers will often discount NRT products – especially around popular "quit dates" such as New Year's Day (Jan.) and the Great American Smokeout (Nov.), sponsored by the American Cancer Society.

Prescriptions and Pretax Savings

In addition to the savings over-the-counter store brand NRT products provide, consumers can also realize potential savings by asking their healthcare provider to write a prescription for these products. By going the prescription route, many insurance providers will offer the same NRT product for the cost of your lowest-tier co-pay, which may be less than the "shelf" price. In many states, Medicaid covers the costs of both over-the-counter NRT products and prescriptions for quitting smoking. For more information on the specific coverage in each state, visit the American Lung Association's website. Other available avenues for savings include:

Many employers offer free medication or assistance for employees looking to quit. It is always worth checking with your human resources department to find out if these resources are available to you.

Some state quit lines may offer free or discounted smoking cessation medication. Learn more by calling 1-800-QUIT NOW.

Tips to Get Started

Your decision to stop smoking is an important one. Tips to get started:

UK Pays People to Slim Down, Stop Smoking

Can people be bribed into better health? The British government is increasingly convinced they can.

For decades, doctors have tried to persuade people to quit smoking, exercise more and lose weight. But with mixed success on the exhortation front and facing a rising obesity crisis, British officials are slowly abandoning the health argument and fattening peoples' wallets instead.

The U.K. has tested several programs that pay people to make healthy choices. Although the trials have been small, officials say they have been successful enough to roll them out further. This week, the government announced it will give out five million 50-pound vouchers to families that can be swapped for fruits and vegetables.

"We will be expanding programs that use financial incentives for healthy behavior where the evidence supports it," said a Department of Health spokesman who did not want to be named, in line with government policy.

Some health experts, however, say it's difficult to change people's habits and warn the cash strategies may backfire. Critics also question whether the government's limited health funds could be better used elsewhere.

But the British government is committed to cash pay-outs to try to reverse the obesity epidemic. In several London suburbs, the public transport system ran a pilot study offering kids movie tickets or shopping vouchers if they walked to school. Similar projects are being considered for other parts of the country.

Britain also commissioned the Weight Wins company to test whether paying people to slim down worked. In eastern and coastal Kent, experts found that 400 people in a 2008 trial lost an average of nearly 15 pounds and kept it off for at least one year.

The program paid people up to 425 pounds ($662) if they hit their weight loss target and maintained it for up to 24 months.

"If people drop out, they get nothing," said Winton Rossiter, who designed the program. "And people hate giving up money even more than they like making it."

Similar programs in the U.S. have largely flopped. An American study that examined seven employer-run programs found that the average person lost little more than a pound.

A pilot project in Scotland, meanwhile, offered poor pregnant women food vouchers worth 12.50 pounds ($19.50) a week if they stopped smoking. After one month, nearly 60 percent of them had, and after three months, almost 35 percent had. By last month, health workers had treated more than 500 women, and there are now plans to unveil the program in the rest of Scotland.

Paul Ballard, deputy director of public health in Tayside, where the project started, said it worked because the amount of money made enough of a difference to women in deprived areas.

But some experts say the success of cash-reward programs is limited because people can't stay on them forever.

"To just pay fat people to eat healthy can work for a bit, but in the real world, they're constantly given the opposite message to eat more," said Tim Lang, a professor of food policy at City University in London who has advised the British government.

"If you want to reduce obesity on a societal level, governments will have to make fundamental changes like altering food price systems to make healthy foods cheaper," he said.

Others question whether Britain should be spending money on these programs when health funds are so tight due to government budget cuts.

"I'm not sure cash-based incentives should be rolled out at the expense of things that are already proven to work," said David Haslam, chairman of Britain's National Obesity Forum.

"There are lots of reasons to be healthy, like looking better and living longer and now maybe earning a bit of cash," Haslam said. "But once you spend that cash, what happens to your motivation?"

40 States Get an 'F' in Tobacco Prevention From New Report Card

A new report card gives the U.S. government relatively high marks for advances in treating people with tobacco-related illnesses, but gives low or failing grades to most states as their anti-smoking programs falter.

The report, from the American Lung Association, finds most states sorely lacking in efforts to get people to stop smoking or help them quit.

"We all can see that public sentiment is turning against smoking," Charles D. Connor, president of the Association, said during a press conference.

"However, it's a grave mistake to assume that the shift in public thinking about tobacco means that the public health crisis has ended. It hasn't," he said.

Each year in the United States, 443,000 people die from illnesses directly related to tobacco use and exposure to secondhand smoke. This makes tobacco the number one cause of preventable deaths, Connor said.

Moreover, tobacco-related illness saps the country of more than $193 billion in health-care costs and lost productivity each year, he added.

"The tobacco companies, meanwhile, aren't relenting in their campaigns of deception," Connor said. "The industry found new ways in 2010 to market its products and target kids."

Connor praised the federal government's efforts to dissuade new smokers and help current smokers quit.

The U.S. Food and Drug Administration began overseeing tobacco products in 2009. So far, the agency has moved to ban the sale of cigarettes and smokeless tobacco to minors, to ban candy and fruit-flavored cigarettes, to prohibit tobacco industry sponsorship of sports and entertainment events, to take enforcement action against electronic cigarette markers, and to require larger health warnings on cigarettes and smokeless tobacco labels.

In addition, the new health care reform law expands programs to help people quit smoking. Most private health insurers will also have to offer treatments to help people quit, and under the Medicaid program, pregnant women will be able to get access to smoking cessation programs, according to the report.

The American Lung Association report card gave the FDA a 'B' for its anti-smoking efforts. But the federal government got a 'C' for failing to cover smoking cessation programs in all federal health care programs and a 'D' for not raising the federal tax on cigarettes. The government also racked up another 'D' for not ratifying the international Framework Convention on Tobacco Control treaty.

And don't even get the ALA started on state lawmakers.

"Most of our states are failing miserably when it comes to combating tobacco-caused disease," Connor said. "Despite collecting millions of dollars, and in some cases billions, in tobacco settlement dollars and excise taxes, most states are investing only pennies of those dollars to help smokers quit and keep kids from starting," he said.

The report faults states for using revenues from tobacco taxes and the tobacco settlement money to balance their budgets instead of using that money to fund anti-smoking and quit-smoking programs. In addition, only six states raised tobacco taxes last year.

The report card grades include an 'F' for 40 states and the District of Columbia for not funding tobacco control programs at recommended levels and an 'F' for 37 states for not making smoking cessation programs part of Medicaid.

No state received straight A's. Arkansas, Montana, Maine, Oklahoma and Vermont were the only states to get all passing grades, although Oklahoma had straight Ds. Alabama, Kentucky, Mississippi, Missouri, North Carolina, South Carolina, Virginia and West Virginia were given F's across the board.

In addition:

Alaska and North Dakota got an A for funding tobacco prevention and control programs at CDC-recommended levels.

Thirty-seven states got F's for not offering tobacco cessation treatments to Medicaid patients and state workers, and not making recommended investments in state quitlines.

Five states got an A for excise taxes of $2.90 per pack or more.

Kansas alone passed a strong smoke free air law in 2010; 27 states now have such laws.

Commenting on the report, Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, said that "it demonstrates that while we have made great progress addressing tobacco use, we still have a long way to go."

There has to be a continued effort to get states to raise tobacco taxes, fund quitting programs and pass smoke-free laws, he said.

"Where the states have really failed is in using their settlement dollars or their tax dollars to fund tobacco prevention programs," McGoldrick said. "In fact, they have been cutting those programs dramatically. We know what happens when you do that: You get more kids smoking, fewer adults trying to quit and smoking rates go up."